MEDICARE: TYLER DARTT PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0033976	OH

General Provider Information

NPI Number	:	1134813710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER DARTT PMHNP

Provider Business Mailing Address
First Line	:	568 PRINCETON ST
Second Line	:
City	:	ASHVILLE
State	:	OH
Zip	:	43103-2518
Country	:	US
Telephone Number	:	614-400-0340
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E. DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2518
Country	:	US
Telephone Number	:	614-953-5219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/25/2023

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